International Notes Dengue -- the Americas, 1984

In 1984, dengue activity in the Americas remained at a
relatively
low level, with 43,435 cases reported from 20 countries (Table 1).
Three dengue serotypes (DEN-1, DEN-2, and DEN-4) circulated in the
region (Figure 1).

Mexico had the greatest activity, with 27,312 cases reported,
and
experienced its first cases of severe hemorrhagic disease with
dengue-associated fatalities in 1984. Three serotypes were
involved,
DEN-1 and DEN-2 on the west coast and DEN-1 and DEN-4 in Yucatan.
Dengue hemorrhagic fever (DHF) occurred in Puerto Vallarta,
Jalisco,
and in Merida, Yucatan. The outbreak in Yucatan included 5,390
reported cases and was caused by DEN-4. Nine patients had
hemorrhagic
disease, and four died. DEN-4 was isolated from one patient who
died
and from two of the other patients with hemorrhagic fever. Five
others were confirmed by IgM-capture enzyme-linked immunosorbent
assay
and/or hemagglutination-inhibition and complement fixation tests,
and
one could not be confirmed.

In Central America, Belize, El Salvador, and Honduras each
reported dengue activity. DEN-1 virus was isolated from cases
during
a small outbreak in Belize. In Honduras, both DEN-1 and DEN-2
virus
transmission were confirmed, but disease occurrence was only
sporadic.

In most of the Caribbean islands, the extent of dengue virus
transmission was limited in 1984. DEN-1 and DEN-4 transmission was
confirmed in the Dominican Republic, while Haiti had confirmed
cases
of both DEN-1 and DEN-2. Puerto Rico reported 1,872 clinical
cases,
but only six were confirmed. In Puerto Rico, DEN-1 and DEN-2
viruses
were isolated for the first time since 1982 and 1978, respectively.
Three cases of DEN-1 were confirmed in the U.S. Virgin Islands. A
large outbreak of DEN-1 occurred in Aruba, the Netherlands
Antilles,
beginning in December 1984. Two fatal cases of hemorrhagic disease
were reported, one of which was confirmed as DEN-1 by virus
isolation. Low-level DEN-1, DEN-2, and DEN-4 transmission was
confirmed in Trinidad. Other Caribbean islands reported sporadic
transmission, but the virus serotypes are not known.

Editorial Note

Editorial Note: Dengue has been endemic in the Americas for over
200
years. Recently, the disease appears to be following a pattern
similar to that in Southeast Asia 30 years ago, where many
countries
began to report increased occurrence of sporadic cases of DHF in
association with increased incidence of dengue infection. This was
followed by major epidemics of the disease in Southeast Asia, and
today, DHF is one of the leading causes of hospitalization and
death
among children in many countries of that region. A similar
sequence
of events appears to be occurring in the Americas in the 1980s.
For
example, Cuba, where no dengue had been reported for 30 years,
experienced a DEN-1 epidemic in 1977, followed in 1981 by a major
DHF
epidemic caused by DEN-2, with 158 fatalities. In 1978, Mexico
reported its first cases of dengue in many years, and within 6
years,
the disease became endemic in most coastal areas of the country.
In
1984 the first DHF cases associated with epidemic dengue were
reported.

Other countries in the region have also reported increased
occurrence of sporadic cases of DHF. This sequence of events, plus
the fact that all four serotypes are now endemic in the region,
suggest that Caribbean Basin countries are at risk for outbreaks of
DHF and underscore the need for more effective surveillance that
will
facilitate prevention and control of the disease.

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